State Health Plan Charter School Presentation. November 2017

Transcription

1 State Health Plan Charter School Presentation November 2017

2 Overview of Topics State Health Plan Overview Legislation and Process New Group Setup Eligibility and Enrollment Group Premiums Overview of Plan Options Employing Retired Teachers in a Full-time Position 2

3 State Health Plan Overview The State Health Plan provides health care coverage to more than 719,000 teachers, state employees, retirees, current and former lawmakers, state university and community college personnel, local governments, and their dependents. The State Health Plan is a division of the Department of State Treasurer. The Treasurer is responsible for administering and operating the State Health Plan. An Executive Administrator oversees the day-to-day operations of the Plan. The Plan is governed by a Board of Trustees consisting of 10 members. The State Treasurer serves as the ex officio chair. The State Health Plan is governed by North Carolina General Statute 135 Article B and must adhere to Section 125 of the Internal Revenue Code; therefore, groups must follow the Plan s rules as established. 3

4 Legislation and Process As required in NCGS , a Charter School Board of Directors must submit the election to join the Plan in writing no later than 30 days after both parties (the State Board and the applicant) have signed the written charter under G.S. 115C E. A copy is required to verify the date signed after the election is submitted. Send required documents to the State Board of Education, and the State Health Plan s Executive Administrator: Dee Jones, Executive Administrator State Health Plan for Teachers and State Employees 3200 Atlantic Avenue Raleigh, NC or HBRInquiries@nctreasurer.com Election is irrevocable The Board of Directors shall notify each employee of the election in writing whether the board elects to become a participating employer in the Plan. Each employee shall acknowledge receipt 4

5 New Group Setup Contact at State Health Plan Howard Michael, Important resources and tools are available on the State Health Plan website at Click on green button that states 2018 State Health Plan Benefits Take a Look. Once the Plan receives the election to participate letter, the Plan will send a Group Setup form to start the implementation process. Training and resources are provided to explain the implementation process. This will equip you with the knowledge you will need to educate your employees on their health plan options, and to show you how to use eenroll, the Plan s online enrollment system. 5

6 How to Enroll Paperless Enrollment Enroll online through eenroll, the Plan s online enrollment system Instructions for enrolling via eenroll can be found on the Plan s website at Click Enroll Now/Access Benefits to get started. 6

7 Eligibility for Permanent Employees Permanent employees Working 30 Hours Per Week May enroll themselves and their eligible dependents. Employee is eligible for employer share. Working 20 Hours but Less than 30 Hours Per Week May enroll themselves and their eligible dependents but must pay full cost of coverage. 7

8 Who is an Eligible Dependent? Legal spouse Children up to age 26* Natural Legally adopted Foster children Children under legal guardianship Stepchildren *A child s coverage may be extended beyond age 26 if the child is physically or mentally incapacitated and the condition developed before their 26th birthday and the dependent was covered by the State Health Plan. Members are required to provide documentation to verify the eligibility of their dependents when enrolled in health coverage. 8

9 When Can You Enroll? Employees of new groups are eligible to enroll the first of the month that the group elects to join the Plan. After the group is on the Plan, the effective date for new hires is the first of the month or first of the second month following date of hire. Hired: Can elect coverage until: Effective date of coverage: October 15 November 15 Either Nov. 1 or Dec. 1, depending on when enrolled Dependents must be added at time of the employee s enrollment or can be added within 30 days of a qualifying life event or during Open Enrollment. Documentation is required to validate the status change. 9

10 Group Premiums Prepaid Plan Billed monthly for the next month i.e., June bill is for July Bills are generated in the middle of the month Premium is due by the first of the next month and must be paid as billed If premium is not paid by the due date, claims are held Premiums not received by the fifteenth day of the month following the due date shall be charged 1 ½% interest of the amount due the Plan, per month beginning with the sixteenth day of the month following the due date. (NCGS ) ebilling administered by Blue Cross and Blue Shield of North Carolina (BCBSNC) offers paperless invoices, electronic one-time and recurring payments, on-demand and scheduled reporting 10

11 Overview of Plan Options The State Health Plan offers two plan options in 2018: Consumer-Directed 80/20 Health Plan Plan 85/15 (CDHP) Members pay a 20% coinsurance for eligible in-network services. For some services (i.e., office visits, urgent care or emergency room visits), members pay a copay. Affordable Care Act (ACA) Preventive Services performed by an in-network provider are covered at 100% in this plan. 70/30 Plan Services are subject to deductible and coinsurance maximum. Members pay 30% coinsurance for eligible in-network expenses. For some services (i.e., office visits, urgent care or emergency room visits), members pay a copay. Affordable Care Act preventive services and medications require the applicable copay under this plan. Review the Plan Comparison on the Plan s website for a side-by-side comparison of both plans. 11

12 80/20 Plan Annual Deductible Coinsurance Medical Coinsurance Max 2018 In-Network $1,250 Individual $3,750 Family 2018 Out-of-Network $2,500 Individual $7,500 Family 20% eligible expenses after deductible 40% of eligible expenses after deductible and the difference between the allowed amount and the charge N/A N/A Medical Out-of-Pocket Max Pharmacy Out-of-Pocket Max Total Out-of-Pocket Max (Includes Deductible) $4,350 Individual $10,300 Family $2,500 Individual $4,000 Family $6,850 Individual $14,300 Family $8,700 Individual $26,100 Family $2,500 4,000 Family $11,200 Individual $30,100 Family ACA Preventive Services Covered at 100% Dependent on Service Office Visits Selected PCP Non-selected PCP Office Visits B.O.D. Specialist. Non-B.O.D. Specialist $10 $25 $45 $85 40% after deductible 40% after deductible 12 B.O.D. = Blue Options Designated Provider

13 80/20 Plan 2018 In-Network 2018 Out-of-Network Urgent Care $70 $70 Emergency Room (Copay waived w/ admission or observation stay) Outpatient Hospital $300, then 20% after deductible 20% after deductible $300, then 20% after deductible 40% after deductible Inpatient Hospital B.O.D. Non-B.O.D. $0, then 20% after deductible $450, then 20% after deductible $450, then 40% after deductible Therapy Services (Chiro/PT/OT) $52 40% after deductible Drugs Tier 1 (Generic) Tier 2 (Preferred Brand & High-cost Generic) Tier 3 (Non-preferred Brand) Tier 4 (Low-cost/Generic Specialty) Tier 5 (Preferred Specialty) Tier 6 (Non-preferred Specialty) Preferred Diabetic Supplies* $5 $30 Deductible/Coinsurance $100 $250 Deductible/Coinsurance $5 $5 $30 Deductible/Coinsurance $100 $250 Deductible/Coinsurance $5 13 B.O.D. = Blue Options Designated Provider *Non-preferred Diabetic Supplies will be priced at Tier 3.

14 80/20 Plan Provider Questions? BCBSNC at Members who choose to enroll in the 80/20 Plan will continue to have additional wellness incentives available that lower out-of-pocket costs for various health care services you receive throughout the year. Additional Wellness Activities Visit the PCP listed on your ID card or another provider in the same practice Visit a Blue Options Designated Specialist* Get inpatient care in a Blue Options Designated Hospital * Reduced Copay $10 copay $45 copay $0; copay not applied Blue Options Designated specialists and facilities refer to hospitals and providers who meet certain levels of criteria which include delivering quality health outcomes, cost effectiveness and accessibility by members. The specialties in which you may find a Blue Options Designated provider are: General Surgery, OB/GYN, Orthopedics, Cardiology, Neurology, Endocrinology and Gastroenterology. To find a Blue Options Designated provider or hospital, visit Blue Connect and look for the label Designated for Cost and Quality or call. To access Blue Connect, visit the State Health Plan s website at and click Enroll Now/Access Benefits to log into eenroll, the Plan s enrollment system. Once you re logged into eenroll you will see a Blue Connect Quick Link. 14

15 70/30 Plan Annual Deductible 2018 In-Network $1,080 Individual $3,240 Family 2018 Out-of-Network $2,160 Individual $6,480 Family Coinsurance 30% of eligible expenses after deductible 50% of eligible expenses after deductible and the difference between the allowed amount and the charge Medical Coinsurance Max Pharmacy Max Out-of-Pocket Max (Includes Deductible) $4,388 Individual/ $13,164 Family $3,360 N/A $8,776 Individual/ $26,328 Family $3,360 N/A ACA Preventive Services Cost-Sharing Applies ($40 for Primary Care $94 for Specialists) Only certain services are covered Office Visits PCP Copay $40 50% after deductible Office Visits Specialist Copay $94 50% after deductible 15

16 70/30 Plan 2018 In-Network Urgent Care $ Out-of-Network $100 ER (Copay waived w/ admission or observation stay) $337, then 30% deductible $337, then 30% deductible Outpatient Hospital Inpatient Hospital 30% after deductible $337, then deductible/30% coinsurance 50% after deductible $337, then deductible/50% coinsurance Therapy Services (Chiro/PT/OT) $72 Copay 50% after deductible Drugs Tier 1 (Generic) Tier 2 (Preferred Brand & High-cost Generic) Tier 3 (Non-preferred Brand) Tier 4 (Low-cost/Generic Specialty) Tier 5 (Preferred Specialty) Tier 6 (Non-preferred Specialty) Preferred Diabetic Supplies* $16 $47 $74 10% up to $100 25% up to $103 25% up to $133 $10 $16 $47 $74 10% up to $100 25% up to $103 25% up to $133 $10 16 *Non-preferred Diabetic Supplies will be priced at Tier 3.

17 Employer Contribution The State Budget provided an increase of 4% in the monthly employer contributions for 2018: $387.44/month for the Medicare primary population $498.68/month for the non-medicare primary population 17

18 Wellness Premium Credit Opportunity Active members can reduce their employee-only premium on both the 80/20 and 70/30 plans by completing the tobacco attestation. Completing the tobacco attestation will lower the subscriber premium by $60. To earn the premium credit the employee must attest to either not using tobacco or agree to enroll in the QuitlineNC program. Attest to being tobacco-free OR enroll in QuitlineNC. (Subscribers only) The tobacco attestation premium credit applies only to the employee premium. It does not apply to spouses or dependents. 18

19 2018 Premium Rates Monthly premiums for all members and plans can be found on the State Health Plan website at Monthly Premium Rates 2018 Rates * 80/20 Plan Subscriber Only $50.00 Subscriber + Child(ren) $ Subscriber + Spouse $ Subscriber + Family $ /30 Plan Subscriber Only $25.00 Subscriber + Child(ren) $ Subscriber + Spouse $ Subscriber + Family $ *Assumes completion of tobacco attestation. The premium will be $60 higher per month if the tobacco attestation is not completed. 19

20 Pharmacy Benefits Pharmacy Benefits administered by CVS Caremark Custom, closed formulary - certain drugs are not covered. A Formulary Exclusion Exception Process is available. Some medications: Require step therapy or prior authorization Have quantity limits Pharmacy Benefit Preferred Drug List (PDL): Recommends drugs for effectiveness/price Preferred Options for non-covered medications Updated quarterly CVS Caremark has a broad pharmacy network, and Plan members do not have to go to a CVS pharmacy for prescriptions. For more information, visit or call CVS Caremark at (888)

21 High Deductible Health Plan (HDHP) 21

22 HDHP for Non-Permanent Full-Time Employees To avoid tax penalties under section 4980H of the Internal Revenue Code (the Code), employers must offer health coverage to all full-time employees. Employees are considered full-time, and thus required to be offered employersponsored health care, if they are reasonably expected to work 30 hours per week. Employing units are responsible for determining whether or not an employee is a full-time employee. This includes all non-permanent employees. The State Health Plan is not able to provide guidance to employing units regarding eligibility for employees. Additional information is posted on the Plan s website under the Health Benefits Representatives tab. Click Health Care Reform/Affordable Care Act Information and under Plans for Active Employees. 22

23 Employing Retired Teachers in a Full-time Position In adherence to , a retiree employed full-time (30 hours or more) under an employing unit is no longer eligible for health coverage under the Retirement Systems and the employing unit is responsible for paying the employer premiums. Permanent full-time rehired retirees are eligible for the traditional plans (70/30 Plan and 80/20 Plan) For retirees hired in a non-permanent full-time position, the employing unit has the option to offer them the High Deductible Health Plan (HDHP) or the traditional plans. 23

24 High Deductible Health Plan Summary Medical Coverage Deductible $5,000 $10,000 $10,000 $20,000 Coinsurance 50% 50% 60% 60% Out-of-Pocket Maximum (Medical and Pharmacy) $6,450 $12,900 $12,900 $25,800 ACA Preventive Care Services $0 (covered at 100%) $0 (covered at 100%) 60% after deductible 60% after deductible Office Visits Specialist Visit Inpatient Hospital 2018 CVS/Caremark Formulary Covered Prescription Drugs 50% after deductible 50% after deductible 60% after deductible 60% after deductible 50% after deductible 50% after deductible 60% after deductible 60% after deductible 50% after deductible 50% after deductible 60% after deductible 60% after deductible Prescription Coverage 50% after deductible 50% after deductible 60% after deductible 60% after deductible Third Party Claims Administrator MedCost 24

25 HDHP Monthly Premium Rates Coverage Type Employee Monthly Premium Employee $96.00 Employee + Child(ren) $ Employee + Spouse $ Employee + Family $ Employer Pays $ itedium manages the online enrollment and billing. 25

26 NC HealthSmart The State Health Plan s healthy living initiative: Empowers healthy members to stay healthy Offers resources and programs including: Worksite Wellness Personal Health Portal Tobacco Cessation Supports 26

27 Thank You!